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General NPI Number Information
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NPI Number | 1215504121
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Entity Type | Individual
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Provider Name | YEN KIM VO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 385 W BROADWAY
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City | BOSTON
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State | MA
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Zip | 02127-2217
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Country | US
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Telephone | 617-610-6623
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Fax |
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Provider Business Mailing Address
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Address Line | 40 MONMOUTH ST
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City | BOSTON
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State | MA
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Zip | 02128-1308
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Country | US
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Telephone | 617-610-6623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1859005
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License Number State | MA
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